SSA is the basic form all Social Security disability claimants must fill out to apply for Social Security disability benefits. You may fill it out yourself or, if it. Create a Form Ssa Bk in minutes using a step-by-step template. A Form SSA BK is known as an Adult Disability Report. DISABILITY REPORT – ADULT – Form SSABK. If you need help with this form, do as much of it as you can, and your interviewer will help you finish it.

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If you found this page helpful, please share it with others by pressing one of these magic little 33368 If the applicant is currently working, provide information about any changes in his or her work activity. If anyone other than your main health care provider has medical information regarding your condition, fill out Section 9. Information about this employer accommodation is not available to SSA in an earnings record, so it is important to provide details on the SSA Tips and ideas for answering questions: You can use this as a guide to fomr for completing the SSA Enter the asa or type of business.

Section four contains some simple yes or no questions regarding work activity. Type of treatment received. Include all information including for, frequency, and the name of the physician who prescribed you the medication. Disability Report SSA — If this section applies, provide information about any vocational rehabilitation or supportive services the applicant has received.

Note that the date provided in this section for when the applicant stopped working, or when their conditions became severe enough to prevent them from working, should match the date provided in the SSA and SSA Please do not list your current medical doctor in this section, you will be asked for his or her information later on.

Bear in mind that filling out form SSA is only the first step in claiming disability benefits. Also, be sure to prepare the people that you have listed on this form so that they will be expecting a call from the SSA.


For applicants who stopped working, SSA will ask if they stopped because of their conditions or other reasons. If the applicant underwent evaluations or treatment while incarcerated, you can add this information to either section 8 or 9. Include all medical sources that have examined or treated the applicant for physical or mental conditions, even if they are not recent.

Otherwise, the claim could experience delays at SSA. If your claim is denied, the SSA will let you know and provide you with information on the appeal process. Make use of this space to give the SSA a complete description of your disabling condition. Leave a Reply Cancel reply Enter your comment here If you have had more than one job, skip the rest of the section and move on to Section 7.

Section 11 gives you an opportunity to provide any other important information that you feel may not have been covered in the other sections of this form.

Expensive, but cheaper than hiring a lawyer. This can be a friend, relative, coworker, or anyone else who can attest to your disability. You can apply for Social Security Disability online, on paper, in person, on the phone or through a lawyer.

List all medications—prescription or non-prescription, that you take on a regular basis. Applicants may be approved on a combination of physical and mental health conditions, so it is important to be comprehensive in this section.

For example, an applicant may be able to work 10 hours per week, but his employer allows extra breaks and a flexible schedule when the applicant experiences anxiety. Most claimants would benefit from the help and advice of an experienced Social Security disability lawyer when filling this form out. If the applicant had more than one job in the last 15 years before he or she became unable to work, do not answer the rest of the questions in Section 6 and go to Section 7.


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For applicants experiencing homelessness, provide an address where they are comfortable receiving mail. Be sure to include all information available to you.

How to Fill out Form SSA

Skip to content Robin Mead You can apply for Social Security Disability online, on paper, in person, on the phone or through a lawyer. It asks for the same kinds of information as the Online Adult Disability Report. This section is only for individuals who are already receiving SSI.

For swa application to be considered a SOAR-assisted application, case managers must provide all the materials discussed previously, i. If the applicant does not remember their job title, add a generic title that describes the tasks performed. The second section requires that you provide contact information for someone who is familiar with your disabling condition. If possible, collect this information from the prescription s or prescription bottles. Simply provide the required information and double check to make sure that it is accurate.

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How to Fill out form SSA-3368

If the applicant has someone other than the SOAR representative helping them with the application, you can enter multiple contacts in this section. Leave Section 10 alone unless you are already collecting SSI. SSA will also ask if the applicant had changes in his or her work activity prior to the date he or she stopped working. Applicants only need to answer one of these sections, depending on their situation.

List the jobs up to 5 that the applicant has had in the 15 years before he or she became unable to work. Use additional paper if you need to. Section 8 inquires about your medical treatment.

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